Is autologous chondrocyte implantation (ACI) an adequate treatment option for repair of cartilage defects in paediatric patients?

• ACI seems beneficial over other cartilage repair methods in long-term outcome.
• ACI has already been successfully applied in juvenile patients.
• ACI seems eligible for paediatric patients, particularly for large lesions >4 cm2.
• Prospective and retrospective data are essential for risk–benefit evaluation of ACI.
• The quality of reporting outcome of ACI in paediatric patients needs improvement.

Cartilage lesions in the knee of juvenile patients require an effective repair to regain life-long functional activity of the joint. Autologous chondrocyte implantation (ACI) is discussed to be advantageous over other methods for cartilage repair regarding long-term outcome. ACI has successfully been applied in juvenile patients, although currently recommended for patients ≥18 years of age. Only few controlled clinical trials present evidence of efficacy and safety of ACI in adolescent patients. ACI products have to undergo the process of a marketing authorisation application, including the submission of a paediatric investigation plan (PIP). Data from prospective clinical studies or retrospective collection of long-term data in paediatric patients should be submitted for risk–benefit evaluation by the Paediatric Committee (PDCO).